Syphilis: photos, symptoms and treatment
- The causative agent of syphilis
- Transmission paths
- Classification of syphilis
- Symptoms of syphilis
- Congenital syphilis
- Diagnosis of syphilis
- Treatment of syphilis
- Prevention of syphilis
Syphilis is a chronic venereal disease that has defied humanity for many centuries. It is prone to systemic flow and provokes the development of foci of specific inflammation on the skin, mucous membranes and internal organs, and also affects the osteoarticular system of man.
This disease is widespread almost everywhere. Even before the 80s of the last century, there was a decrease in the incidence of syphilis in the world, but by the 1990s its indicators began to grow. Today, according to world statistics, there are about 50 million people suffering from this serious illness.
Even at the beginning of the last century, syphilis was considered to be a male disease. Now the main culprits in the spread of venzabolevaniya are women, illegible in choosing a sexual partner and not using personal protective equipment. It should be noted that today syphilis is most often detected in the layers of a society with low sexual culture.
The causative agent of syphilis
The causative agent of the disease is pale treponema. The name "pale" bacterium has received because of bad coloring by basic dyes. It is an active, mobile, pathogenic gram-negative microorganism of a spiral shape with a thin curved body moving around its longitudinal axis. It was first discovered in 1905 by Hoffmann and Shaudin. Pale treponema is able to develop only in an airless space, i.e. Is an obligate anaerobic.
To date, three major subspecies of treponem have been identified:
- Classical causative agent of syphilis (treponema pallidum);
- The causative agent of endemic syphilis (treponema pallidum endemicum);
- The causative agent of tropical granuloma - non-venous syphilis - (treponema pallidum pertenue).
Pale treponema refers to the spirochaete. In length it reaches 4-14 microns, in diameter - 02-05 microns. The body of this unique bacterium is covered with a mucopolysaccharide substance, which complicates the access of antibodies and phagocytes of the host.
In a living form, pale treponem can be detected by microscopic examination of the infected material.
According to experts, the causative agent of syphilis passes the stage of intracellular development. After the death of the cells, a large number of treponemes exit into the intercellular space and infect neighboring cells of their host.
на искусственных питательных средах данный род бактерий практически не растет, а также быстро погибает вне человеческого организма. Note: on artificial nutrient media this genus of bacteria practically does not grow, and also quickly dies outside the human body. However, in the cold, their viability persists somewhat longer.
Transmission routes for syphilis
The main way of transmission of the disease is sexual. However, in direct contact with a patient in an acute infectious form, there may be a non-domestic (household) infection, and infection can occur through household items contaminated with saliva, pus, or other secretions in which the pathogen is located. Fortunately, at the moment the probability of occurrence of a household syphilis is insignificantly small. This form of the disease can still be found in developing countries with a very low level of sanitary and hygienic skills of the population. As a rule, young children suffer from domestic syphilis.
In the case when a pregnant woman becomes infected with syphilis, infection of the fetus occurs due to transplacental penetration of the pathogen. Often this ends in congenital syphilis or the death of an unborn child.
Classification of syphilis
Syphilis is of two types: congenital and acquired. Further, in accordance with the symptoms, it is classified:
- Primary syphilis (syphilis I primaria);
- Secondary fresh syphilis (syphilis II recens);
- Early hidden form;
- Secondary recurrent syphilis;
- Secondary recurrent;
- Late hidden form;
- Tertiary syphilis;
- Syphilis of the fetus;
- Early congenital syphilis;
- Late congenital syphilis;
- Concealed congenital syphilis;
- Visceral syphilis;
Symptoms of syphilis
Symptoms of primary syphilis
With acquired syphilis, the average duration of the incubation period is about 30 days (less often 15-20 days or several months).
причиной более длительного скрытого периода является прием после заражения бледной трепонемой незначительных доз медикаментозных препаратов, ингибирующих возбудителя. Note: the cause of a longer latent period is the administration after infection with pale treponemal minor doses of drug preparations that inhibit the pathogen.
The first sign of primary syphilis is the appearance of a solid chancre (at the site of infection). As a rule, this formation is localized on the genitals, in the anus area, as well as in other parts of the skin and mucous membranes. In particular, it can be found in the mouth, on the cervix, in women on the nipples or on the fingers. It can be a single or multiple formation (bipolar chancres).
Hard chancre is a painless, rounded form of erosion or a superficial ulcer having smooth, smoothly descending to the center of the edge, surrounded by a healthy cover cloth. Its color can vary from bright red to grayish-yellow (the color of spoiled fat). Most often, the solid chancre has a smooth, shiny surface, under which an exudate infected with a huge amount of treponem accumulates.
However, in ex- ternal areas of the body, exudate can sometimes shrink and form crusts. At the base of the solid chancre there is a seal that resembles the ear cartilage (dense electrostatic infiltrate). Thanks to him, this formation and got its name.
On average, the diameter of the neoplasm is 1 cm, but in clinical practice you can find dwarf chancers the size of a pinhead or giant chancres, reaching 3-4 cm in diameter.
In uncomplicated course, spontaneous healing of the solid chancre occurs (after 1-10 weeks).
Very often, patients infected with pale treponema, because of painlessness, simply do not notice the primary subjective signs of syphilis. However, for the slit-like chancre, which is localized at the bottom of the radial fold of the anal opening, a characteristic soreness is characteristic (due to the fact that it is constantly injured during defecation). Also, a strong pain sensation causes chancre-panaritium (a consequence of a mixed infection), formed on the nail phalanx of the index finger. If the patient has a complicated course of solid chancre (phagadenism, gangrenization, phimosis or paraphimosis), moderate pain sensations are observed.
After 5-7 days after the appearance of the first syphilitic sign, the regional lymph nodes that appear on the path of the lymphatic drainage increase. Primary syphilis for regional lymphadenitis is characterized by a practically painless and uneven increase in some lymph nodes.
This period can last from six to eight weeks. A week and a half before its end, a specific polyadenitis develops (most subcutaneous lymph nodes increase). The patients develop headache, fever, malaise and muscle pain. This symptom is a sign of a massive spread of the causative agent of the infection. Some people infected with pale treponema can develop neurotic disorders or depressive conditions.
Symptoms of secondary syphilis
The secondary period of syphilis without treatment lasts approximately 2 years. During this time, the exacerbation may several times wave-like to be replaced by latent phases with complete absence of symptoms.
The first rashes (papules or roseola) often occur with residual phenomena of solid chancre and scleradenitis. After 1-2 months they pass without a trace, and the period of early latent syphilis begins. After several weeks (months) comes the wave of generalized rashes (secondary syphilis), which lasts about 1-3 months.
As a rule, with the passage of time the duration of latent periods increases, the elements of the rash become larger and are arranged in groups, and the amount of rashes decreases. Most often they can be found on the mucous membrane of the oral cavity or in the perineal region.
For secondary recurrent syphilis is characterized by the appearance of wide condylomas, as well as hair loss and leukoderma (a violation of skin pigmentation). Sometimes on the patient's body it is possible to detect pustular syphilis that do not cause any subjective disorders, and soon disappear by themselves (without treatment).
Despite the fact that during this period there is a particularly skinny symptomatology, pale treponema, seeded all tissues and organs, can cause various forms of meningitis, liver pathology (icteric or jaundiced hepatitis), lipoid nephrosis or other kidney diseases, syphilitic gastritis , uveitis, As well as various lesions of bones and joints. Along with these, serious disorders are noted from the nervous system (obscuration of consciousness, paresis and epileptic seizures, as well as cerebral events).
при проведении своевременного противосифилитического лечения ранние поражения нервной системы полностью устраняются. Note: in the conduct of timely antisyphilitic treatment, early lesions of the nervous system are completely eliminated.
Symptoms of tertiary syphilis
Tertiary syphilis is characterized by a prolonged latent flow. It can manifest itself in 3-4 years (with complete absence of treatment, or with insufficient treatment). Most often this form of pathology can be found in patients suffering from chronic alcoholism, tuberculosis or other infections.
During this period, a small number of dense infiltrates localized in the subcutaneous tissue or in deeper tissues are found on the skin and mucous patients. After some time, they disintegrate, and in their place there are painless sores, which are scarred only after a few months or years. It should be noted that such syphilides are not accompanied by subjective disorders and do not disturb the general condition of the patient. They contain very little pathogen, which is why they are practically not contagious.
Symptoms of visceral syphilis
When visceral lesion affects almost all the organs of the patient, but most often - the cardiovascular system. Often patients complain of shortness of breath and constant chest pains. With syphilitic aortitis, mitral and aortic valve insufficiency develops, and the ascending aorta thickens.
Another early symptom of visceral syphilis is the defeat of the digestive tract, which occurs with a violation of the liver.
At the beginning of the secondary period, patients develop renal pathologies. In this case, benign proteinuria, glomerulonephritis or a specific lipoid nephrosis is most often observed.
On the part of the respiratory system, bronchopneumonia, dry bronchitis or interstitial pneumonia can be diagnosed.
In the development of late syphilis of bones, periostitis, osteoperiostitis, osteomyelitis of flat and tubular bones, as well as syphilitic synovitis and osteoarthritis are diagnosed in patients.
Symptoms of late neurosyphilis
After 10-15 years from the onset of the disease, latent meningitis is revealed in patients (very resistant to antisyphilitic therapy). In late diffuse meningovascular syphilis, with severe symptoms of meningitis, there is a lesion of the blood vessels, in which cranial nerves are often involved, sensitivity is impaired, gammas of the brain or spinal cord (soft tumors characteristic of the tertiary stage of syphilis) and other neurological disorders are identified.
To date, congenital syphilis is a fairly rare pathology. It occurs due to intrauterine infection of the fetus, which most often can occur when the mother is diagnosed with an early stage of syphilis. Sometimes congenital syphilis is asymptomatic, but at the same time, in clinical practice, there are cases when the fetus is diagnosed with white pneumonia, liver damage, tubular bones and endocrine glands. Often this condition during the 6th-7th month of pregnancy leads to the death of the fetus. Also, miscarriage may occur at a later date or the birth of a sick child.
The most severe congenital syphilis occurs at an early age (up to 2 years). The child is born with a dull wrinkled skin of dirty yellow color, he is diagnosed with specific pneumonia, dystrophy and syphilitic pemphigus (appearance on the palms and soles of blisters with serous contents). Early congenital syphilis occurs on the background of skin lesions, airway pathologies, central nervous system and vision organs.
Late congenital syphilis is diagnosed in children 4-5 years of age. At this time, a few rashes appear on the skin and mucous membranes of the child, as well as lesions of internal organs and osteosclerosis.
Often in patients with congenital syphilis, there is no xiphoid process of the sternum, the length of the little finger is much shorter than the normal ("infantile pinkie"), a "gothic" (high) palate is found, and the dystrophy of the skull (the buttock-like skull) and the thickening of the sternal end of the right collarbone can be observed.
Diagnosis of syphilis
Diagnosis of syphilis includes visual examination of the patient, collection of an epidemiological anamnesis, as well as laboratory research methods.
In laboratory practice several methods are used to detect syphilis:
- – самый распространенный и наиболее доступный способ обнаружения возбудителя заболевания. The serological method is the most common and most accessible way of detecting the pathogen. This technique involves the detection of immunoglobulins, which develops the immune system of a person who has syphilis. Wassermann's reaction, or, as it is called, the complement binding reaction, is based on the fact that the serum of the patient forms a complex with the antigen that adsorbs the compliment.
- – это быстрый тест, который также основан на иммунологической реакции антитело-антиген. The microprecipitation reaction is a rapid test, which is also based on the immunological antibody-antigen reaction.
- . The reaction of immunofluorescence (RIF) . This is the most accurate method that is used in laboratory practice to detect latent syphilis. As a rule, it is used in difficult and atypical cases, as well as in the diagnosis of late syphilis.
Treatment of syphilis
The main method of treating syphilis is antibacterial therapy. At the moment, as before, antibiotics penicillin series (short and prolonged penicillins or durant penicillin medications) are used. In the case when this type of treatment is ineffective, or the patient has an individual intolerance to this group of drugs, he is prescribed drugs of the reserve group (macrolides, fluoroquinolones, azithromycins, tetracyclines, streptomycins, etc.) It should be noted that in the early stage of syphilis, antibacterial Treatment is most effective and leads to complete cure.
The attending physician in the course of treatment can correct his scheme, and also, if necessary, prescribe a repeated course of antibiotic therapy.
An important criterion for the patient's recovery is the control serological reactions.
In parallel with the antibacterial patient, immunostimulatory therapy is prescribed. Also, non-specific treatment is mandatory (vitamin therapy, biogenic stimulant injections, pyrotherapy and ultraviolet irradiation).
During the treatment, any sexual contact is prohibited, as this can lead to infection of the sexual partner or to a re-infection of the patient.
если произошел незапланированный половой контакт без использования средств индивидуальной защиты (или с нарушением целостности презерватива в процессе полового акта), специалисты рекомендуют сделать профилактическую инъекцию, практически на 100% предотвращающую развитие сифилиса. Note: if unplanned sexual intercourse occurs without the use of personal protective equipment (or with a violation of the integrity of the condom during intercourse), experts recommend a preventive injection that almost 100% prevents the development of syphilis.
Prevention of syphilis
After treatment, patients must be on dispensary supervision (for each form of syphilis there is an appropriate period, specified by the instruction). Such methods provide clear control over the successful implementation of antisyphilitic therapy. Without fail, all the sexual and domestic contacts of the patient must be identified, examined and sanitized in order to prevent the spread of infection among the population.
During the entire period of follow-up, patients who have had syphilis are required to abstain from sexual intercourse, and they are also forbidden to be blood donors.
Public measures of prevention are considered:
- Annual prophylactic medical examination of the population (over 14 years) providing blood donation to the RMP.
- Regular screening for syphilis of persons at risk (drug addicts, homosexuals and prostitutes).
- Examination of pregnant women for the prevention of congenital syphilis.
Pregnant women who had been ill with syphilis and already taken off the register are prescribed additional preventive treatment.
- Tertiary syphilis
- Secondary syphilis
- Primary syphilis: symptoms, treatment
- Syphilis in women: symptoms and signs